Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by shoulder stiffness, pain and significant loss of passive range of motion. It affects 2-5 % of the population. It is an inflammatory condition that can cause long-term disability in 10 – 20% of patients and causes persistent symptoms in 30 – 60% of patients. The mean age of onset is 55 years. It is more predominant in women. It typically develops slowly, progressing through stages and often taking one to three years to resolve.
Adhesive capsulitis, or frozen shoulder, generally develops gradually, and its symptoms can be broken down into three stages:
Freezing Stage (Painful Phase):
Gradual onset of shoulder pain with movement. Pain may be worse at night, particularly when lying on the affected side. Progressively limited range of motion; the joint becomes increasingly stiff. This stage may last from 6 weeks to 9 months.
Frozen Stage (Adhesive Phase):
Pain may begin to decrease, but the stiffness remains or even increases. The shoulder may become difficult to use; daily activities that involve reaching or lifting may be particularly challenging. This stage may last from 4 to 6 months.
Thawing Stage (Recovery Phase):
Gradual improvement in the range of motion. Continued decrease in pain. This stage can last anywhere from 6 months to 2 years.
The pain is typically a dull ache that is worse in the early stages and when the arm is moved. In some cases, the condition may progress to the point where even simple tasks become painful and challenging. The reduction in mobility can seriously impact daily activities like dressing, showering, or reaching overhead.
The cause of frozen shoulder is not fully understood, but it can be associated with diseases like diabetes and hypothyroidism, and often follows an injury or surgery where the shoulder has been immobilized.
The capsule of the shoulder joint has ligaments that hold the shoulder bones together. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint. The shoulder capsule thickens, tightens, and forms stiff bands of tissue called adhesions.
Dr. Reynolds will review the patient’s medical history and inquire about the symptoms and indications of the stages of the condition. During the physical exam, Dr. Reynolds will carefully test range of motion and may find a decrease in both active and passive movement in the shoulder, affecting forward flexion, abduction, and both external and internal rotation.
He will also attempt to rule out other diseases and conditions with similar symptoms such as fracture, malignancy, rotator cuff impingement, shoulder impingement and cervical radiculopathy (a pinched nerve in the neck). To rule these out he may need to order X-rays or an MRI.
Pain often limits the ability to conduct a complete physical exam. In patients with a severe form of the condition, the natural swinging motion of the arm that occurs during walking may be lost. There is no lab test.